| CRITERIA MEASURE |
Met |
Not Met |
Comments |
Refer to Department |
 Pest and Rodent Control systems in place and managed |
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| Preventive Maintenance Program exists |
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| Logs reflect active preventive maintenance |
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| Medical Equipment Testing can be verified |
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| Infection Control precautions are utilized for all housekeeping staff |
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| Spills are cleaned using universal precautions |
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| Wet floor hazard signs are utilized by staff |
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| Cleaning supplies on carts are stored and locked appropriately |
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| Disinfectant is used on all contact surfaces |
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| Oxygen delivery system maintenance is checked at least weekly |
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| Product recalls are addressed and managed promptly |
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| Grounds are maintained: parking lot, sidewalks, automatic doors, etc |
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| Environmental safety tours are conducted at least monthly |
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| Mechanical systems are assessed according to manufacturer's recommendations |
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| Smoking is prohibited inside the building |
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| Compressed gasses are stored properly and away from patient care areas |
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| All staff wear appropriate identification when on clinic grounds |
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| One staff member is designated as media contact; staff are instructed not to speak to media |
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| Hazardous materials are disposed properly: |
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| Bio-waste |
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| Chemicals |
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| Radioactive materials |
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| Infectious medical waste; including sharps disposal |
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| Hazardous gases |
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| MSDS sheets are available for all staff who access hazardous materials |
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| Hazardous environmental risks are evaluated at least annually |
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| The clinic participates in the community emergency response plan |
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| Fire management plan is current and updated at least annually |
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| Fire drills are conducted according to local and state requirements and at least quarterly on all shifts |
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| Fire suppression system is maintained and inspected according to local and state requirements |
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| Fire drills are assessed for participation, accurate and prompt response |
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| Carbon dioxide and other gaseous systems tested at least annually |
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| Slip fall hazards are identified and removed on a daily basis |
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Copyright © OmniSure Consulting Group, Inc., 2008
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